基于中医时间医学理论指导参附注射液择时用药治疗阳气暴脱型感染性休克的临床研究  

Clinical research on timing medication of shenfu injection guided by time medicine of traditional Chinese medicine for infective shock of yang-energy sudden collapse

作　　者：李敏 陈建荣[1] 顾鹏[1] 李峰[1] LI Min;CHEN Jianrong;GU Peng;LI Feng(Deparment of Emergency,Nantong First People's Hospital,Jiangsu,Nantong 226001)

机构地区：[1]江苏省南通市第一人民医院急诊科,江苏南通226001

出　　处：《河北中医》2021年第9期1457-1461,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：江苏省南通市科学技术局科技项目(编号:HS2018002)。

摘　　要：目的探讨基于中医时间医学理论指导参附注射液择时用药治疗阳气暴脱型感染性休克的临床疗效。方法将126例阳气暴脱型感染性休克患者按照随机数字表法分为4组,对照组31例予西医常规治疗,子时治疗组32例、辰时治疗组31例、午时治疗组32例均在对照组基础上予参附注射液治疗,其中子时治疗组于23:00—1:00用药,辰时治疗组于7:00—9:00用药,午时治疗组于11:00—13:00用药。4组均治疗1周后统计疗效,比较4组治疗前后急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分及中医症状(包括神志淡漠、面色苍白、四肢厥冷、冷汗淋漓、息微唇绀及体温不升)评分变化情况,比较4组治疗期间多器官功能障碍综合征及死亡的发生情况。结果子时治疗组总有效率90.63%(29/32),辰时治疗组93.55%(29/31),午时治疗组93.75%(30/32),对照组67.74%(21/31),子时治疗组、辰时治疗组、午时治疗组总有效率均高于对照组(P<0.05),但3个治疗组组间比较差异无统计学意义(P>0.05)。4组治疗后APACHE-Ⅱ评分、SOFA评分、中医症状神志淡漠、面色苍白、四肢厥冷、冷汗淋漓、息微唇绀、体温不升评分及总分与本组治疗前比较均降低(P<0.05),且子时治疗组、辰时治疗组、午时治疗组治疗后各项评分均低于对照组(P<0.05),3个治疗组组间比较差异也均有统计学意义(P<0.05),午时治疗组各项评分最低,其次是辰时治疗组,最后是子时治疗组。子时治疗组治疗期间多器官功能综合征发生率15.63%(5/32),死亡率6.25%(2/32),辰时治疗组为12.90%(4/31)、6.45%(2/31),午时治疗组为9.38%(3/32)、3.13(1/32),对照组为41.94%(13/31)、12.90%(4/31),4组治疗期间死亡率组间比较差异均无统计学意义(P>0.05),但子时治疗组、辰时治疗组、午时治疗组多器官功能综合征发生率均低于对照组(P<0.05),但3个治疗组组间比较差异无统计学意义(P>Objective To explore the clinical effect of timing medication of shenfu injection guided by time medicine of traditional Chinese medicine(TCM)for infective shock(yang-energy sudden collapse).Methods Totally 126 patients with infective shock(yang-energy sudden collapse)were randomly divided into control group(n=31),treatment group 1(Zishi,treatment at period of the day from 11 pm to 1 am,n=32),treatment group 2(Chenshi,treatment at period of the day from 7 am to 9 am,n=31),treatment group 3(Wushi,treatment at period of the day from 11 am to 1 pm,n=32).Patients in control group received conventional western treatment,and patients in three treatment groups received shenfu injection on the basis of control group.Treated for one week,the aim was to compare acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,TCM symptom(spirit indifferent,pale complexion,cold limbs,cold sweating,weak breathing,lip cyanosis,body temperature not rising)score,multiple organ dysfunction syndrome(MODS),and the occurrence of death;the curative effect was counted.Results The total response rates in three treatment group 1,2,3 and control group were 90.63%(29/32),93.55%(29/31),93.75%(30/32)and 67.74%(21/31),respectively,the curative effect being better in treatment groups than control group(P<0.05);the difference among treatment groups being not significant(P>0.05).After treatment,APACHE-Ⅱscore,SOFA score and TCM symptom score in groups were decreased(P<0.05),treatment groups were obviously decreased in comparison with control group(P<0.05),the difference among treatment groups was statistically significant(P<0.05),treatment group 3 was the lowest among treatment groups,followed up treatment group 2 and treatment group 1.The incidence of MODS in treatment group 1,2,3 was better than that in control group[15.63%(5/32),12.90%(4/31),9.38%(3/32)vs 41.94%(13/31),(P<0.05),respectively];the death rate in treatment group 1,2,3 and control group were 6.25%(2/32),6.45%(2/31),3.13(1/32)and 12

关 键 词：休克 感染 中医时间医学 中药疗法 益气固脱 

分 类 号：R364.14[医药卫生—病理学] R631.4[医药卫生—基础医学]